There’s a rallying cry heard often in the battle against opioid addiction: People with opioid dependence need immediate access to treatment, particularly the medications that stop cravings and prevent overdoses.
But a study published this week in the Journal of Psychiatric Practice found that one avenue to addiction treatment — a federal database of clinicians who prescribe buprenorphine, a key antiaddiction medication — is rife with inaccuracies and unlikely to connect patients with care.
“If you go to the database to look up a potential provider, just be aware there’s going to be a lot of wrong numbers. You’re going to have to call a lot of places,” said Dr. J. Wesley Boyd, the study’s senior author and a psychiatrist at the Cambridge Health Alliance and Harvard Medical School.
At issue is the Buprenorphine Practitioner Locator of the US Substance Abuse and Mental Health Services Administration, which lists practitioners authorized to treat opioid addiction with buprenorphine, a drug commonly known by a trade name, Suboxone.
The Web page invites patients to search for clinicians by city, state, or ZIP code.
The researchers pulled up the names of the 505 providers listed for 10 counties with high opioid overdose death rates, including Bristol County, Mass.; Kent County, R.I.; and Coos, N.H.
As if they were patients, although not identifying themselves as such, the researchers tried to reach the 505 practitioners. Sixty-one percent of the phone numbers were found to be correct. Only 195 providers could be confirmed as buprenorphine providers. Only 140 had appointments available. In three counties, none of the providers had appointments available.
Among those with a waiting list, wait times for an appointment averaged 17 days, but two providers in Massachusetts and one in Rhode Island had wait times of 120 days. Calling the number listed for one Rhode Island physician, the researchers were informed he hadn’t worked there in 12 years.
“[The Substance Abuse and Mental Health Services Administration] needs to take steps to ensure the database is accurate,” Boyd said.
But the agency’s leader, Assistant Secretary Elinore McCance-Katz, disagrees. Clinicians, she said, are responsible for keeping their information up to date and can easily do so. As a small agency, SAMHSA could not possibly track them all down, she said.
The database provides the names and contact information of doctors, nurse practitioners, and physician assistants who opted to be listed at the time they received federal permission to prescribe buprenorphine. It makes no claims that treatment will be available on the day the patient seeks it, said a senior SAMHSA official.
“This is a resource that we’ve made available,” McCance-Katz said. “It relies on the practitioner to give us accurate information and to update their information.”
She noted that the researchers looked at only 10 counties, not the whole country, and even acknowledge that they may have missed some return calls.
McCance-Katz defended SAMHSA’s record improving access to addiction treatment, and pointed out that more people take advantage of a more expansive federal website, Findtreatment.gov, which connects patients with a variety of treatments.
Dr. Michael L. Barnett, a health services researcher at the Harvard T.H. Chan School of Public Health who was not involved with the research, said the findings in Wednesday’s study concur with his team’s findings in a similar study of the Buprenorphine Practitioner Locator, published last year in the Annals of Internal Medicine.
“Half of the data in the treatment locator is not workable,” he said. “Of those [who can be reached], there’s a small majority that are actually taking new patients and prescribing buprenorphine.”
He agreed with Boyd that SAMHSA should seek funding to update the database, because “it’s touted by the federal government as a really important resource.”
He suggested that the agency revamp the website to resemble consumer sites like Yelp or Angie’s List by allowing clinicians to “own their profiles and keep up to date more easily.”
The Cambridge Health Alliance researchers identified the 10 states with the highest rates of opioid overdose deaths: West Virginia, New Hampshire, Kentucky, Ohio, Rhode Island, Pennsylvania, Massachusetts, New Mexico, Utah, and Tennessee.
In each state, they selected the county with the highest overdose rate, a group that included Bristol County, Mass., Kent County, R.I., and Coos, N.H. Then they pulled from the database all the providers within 25 miles of the central zip code in each of those 10 counties, capturing an area that didn’t always correspond to county boundaries.
Kent County, R.I., had 150 listed buprenorphine providers, the highest rate per 100,000 residents among the counties studied. But only 59 confirmed that they provide the medication, and only 34 had appointments available.
Bristol County, Mass., had 166 providers listed, the largest number; 73 could be confirmed as buprenorphine providers and 60 had appointments available.
Only two confirmed buprenorphine providers were found in Coos, N.H., but neither had an appointment available.